Computed from CMS’s 2026 fee-schedule files · browser only
What does Medicare pay an LMFT or LPCC in California for a session?
Since 2024 you can bill Medicare directly, at 75% of what it pays a clinical psychologist, and that amount differs across California’s 29 localities. This page runs the fee-schedule formula on CMS’s own RVUs and geographic indices for the seven psychotherapy codes, then splits the result into Medicare’s 80% and the patient’s 20%.
Your locality and code →Your locality and code
Where you practice, what you bill, and your charge.
The locality is the county the service is furnished in (for telehealth from your office, your office’s county). The charge matters only if it is below the allowed amount: Medicare pays on the lesser of the two, and on assignment you cannot bill the patient the difference. Enrollment itself is on the Medicare enrollment page.
Every locality
The same code across California.
| Locality | Psychologist amount | Allowed for you | Medicare pays | Patient pays |
|---|
The chain
Five steps, each with its source.
[(work RVU × work GPCI) + (practice-expense RVU × PE GPCI) + (malpractice RVU × MP GPCI)] × the conversion factor. RVUs and the $33.4009 non-qualifying-APM conversion factor are CMS’s January 2026 relative value file; the GPCIs are its Addendum E; the county-to-locality map its 26LOCCO file. The CY 2026 final rule set two conversion factors; the non-APM one applies to a solo practice.
“You must accept assignment. We pay 75% of the PFS amount for CPs.” MLN1986542, Medicare & Mental Health Coverage, March 2026, under each of the three provider types. The allowed amount is the lesser of your actual charge and that 75%.
“After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for visits to your health care provider to diagnose or treat your condition.” medicare.gov, outpatient mental health care.
“$283 before Original Medicare starts to pay. You pay this deductible once each year.” medicare.gov, 2026 costs. Early in the year the patient may owe the whole allowed amount.
“CMS pays 100% of the Medicare-allowed amount, subject to 2% sequestration reduction established by the Budget Control Act of 2011.” CMS, 2026. It applies to the 80%, not to the patient’s 20%.
Then what
Around the number.
Getting in
Medicare enrollment for California therapists
PECOS, the qualifications, assignment and opting out.
The commercial comparison
Insurance reimbursement rates in California
What the commercial panels pay for the same codes.
Is the rate worth taking?
The insurance offer calculator
A contracted rate against your fee, after the costs of billing it.
The panels themselves
Insurance panels for California therapists
Credentialing, timelines and what each asks for.
Where every figure came from
Sources.
The fee schedule
The payment rules
- CMS, MLN1986542 Medicare & Mental Health Coverage (March 2026): the 75% rule and mandatory assignment for MFTs, MHCs and CSWs
- Medicare.gov, mental health care (outpatient): the 20% coinsurance
- Medicare.gov, costs: the 2026 Part B deductible
- CMS, the 2% sequestration reduction under the Budget Control Act of 2011 (page modified 5 June 2026)
Non-facility amounts only. Medicare Advantage plans pay under their own contracts; this page is Original Medicare. Nothing selected here leaves the browser.
